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Extra Wrinkles a Bad Sign for Smokers

They may point to a heightened risk for lung disease, study suggests

WEDNESDAY, June 14, 2006 (HealthDay News) -- British scientists have discovered a tantalizing new wrinkle in the understanding of smoking's unhealthy effects.

Middle-aged smokers whose faces were heavily wrinkled were five times as likely to have chronic obstructive pulmonary disease (COPD) as smokers whose faces were relatively smooth, the study out of Cambridge University found.

The authors speculated that both COPD and wrinkling may be linked by a common mechanism and that facial wrinkling might indicate susceptibility to the potentially deadly lung disease.

"The association may help us to understand more about the effects of smoking on the body and suggest that the disease process that gives rise to COPD may not be solely confined to the lung," explained study lead author Dr. Bipen Patel, who is now a consultant physician in respiratory medicine at Royal Devon & Exeter Hospital in the United Kingdom.

"It also suggests that premature wrinkling in a smoker may be an indication that they are developing COPD and should be screened for the condition, since it is often not diagnosed in its earliest stages," Patel said. "However, the benefit of this would need to be confirmed in an additional study."

The finding is "certainly biologically plausible," said Dr. Norman Edelman, chief medical officer for the American Lung Association. But he remained skeptical of any clinical implications leading from the study.

"This may be of use in educating patients but, in terms of detection of lung disease, we [already] have a simple breathing test. We don't have to look for wrinkles," he said.

The research appears in the June 14 online edition of Thorax, and was done while Patel was at Cambridge.

COPD refers to a group of progressive chronic lung diseases, including emphysema and bronchitis, which block the airways and restrict oxygen flow.

Some 13.5 million Americans suffer from COPD, and the World Health Organization predicts that the condition will become the third leading cause of death worldwide by 2020.

"It is well known that cigarette smoking is a major risk factor for COPD, although only a proportion of smokers are affected. It is also known that cigarette smokers can develop premature ageing of the skin," Patel said. "We hypothesized that these conditions could be likened to premature ageing of the lung and skin and therefore that there may be a common susceptibility to COPD and skin wrinkling."

However, Edelman noted that not all smokers go on to develop COPD. "Obviously, people vary in their response to what's in the smoke," he said.

In the study, the team wanted to see if genetic factors that predispose smokers to COPD might also predispose them to wrinkles.

The researchers analyzed data on 149 current and former middle-aged smokers, 68 of whom (45.6 percent) had COPD. The participants came from 78 families.

Eighty-three percent had no facial wrinkling or only minor lines, but close to 17 percent had considerable wrinkling.

Lung strength and function, measured in all participants, turned out to be significantly lower in those with extensive wrinkling than in those with smoother faces.

People with heavy wrinkles were also five times more likely to have COPD than those without wrinkles. People with facial wrinkling also had triple the risk of suffering from more severe emphysema.

"We do not know the underlying mechanism," Patel said. "We suspect that the common susceptibility to COPD and wrinkling has a genetic basis; however, the genes that are responsible for this have not been identified. The mechanism may be related to the loss of elastic tissues (such as collagen and elastin) in the lung and skin, but this is not yet proven."

The findings are more likely to be helpful in spurring new research than in providing any direct benefit to patients, Edelman said.

"I think this will be of use to basic biologists," he explained. "Maybe you can start doing experiments on the skin; maybe that's an easier model to use than the lung to figure out what the mechanisms are."

More information

For more on COPD, head to the American Lung Association.

SOURCES: Bipen Patel, MBBS Ph.D., consultant physician in respiratory medicine, Royal Devon & Exeter Hospital, Exeter, U.K.; Norman Edelman, M.D., chief medical officer, American Lung Association; June 14, 2006, Thorax online
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